Topography of the Upper Limb PDF

# Topographic Anatomy of the Upper Extremity ## Plan of the lesson - Topography of the scapular region - Topography of the axillary region - Axillary artery - Topography of the deltoid region - Topography of the infraclavicular region (Subclavian region) - Superior trilateral foramen - Inferior tr...

# Topographic Anatomy of the Upper Extremity ## Plan of the lesson - Topography of the scapular region - Topography of the axillary region - Axillary artery - Topography of the deltoid region - Topography of the infraclavicular region (Subclavian region) - Superior trilateral foramen - Inferior trilateral foramen - Quadrilateral foramen - Topography of the shoulder joint - Topography of the anterior region of the arm - Topography of the posterior region of the arm - Canal of the radial nerve - Topography of the elbow region - Topography of the cubital region - Topography of the anterior cubital region - Topography of the anterior cubital region - Topography of the anterior cubital region - Topography of the anterior cubital region - Topography of the posterior cubital region - Topography of the posterior cubital region - Topography of the posterior cubital region - Topography of the elbow joint - Topography of the elbow joint - Topography of the elbow joint - Topography of the forearm - Topography of the anterior region of the forearm - Topography of the posterior region fo the forearm - Topography of the posterior region of the forearm - Topography of the posterior region of the forearm - Spaces of the forearm - Topography of the wrist joint - Topography of the wrist joint - Topography of the wrist joint - Topography of the wrist joint - Topography of the hand region - Topography of the anterior (palmar) region of the hand - Topography of the anterior (palmar) region of the hand - Topography of the anterior (palmar) region of the hand - Topography of the posterior (dorsal) region of the hand - Topography of the posterior (dorsal) region of the hand - Topography of the posterior (dorsal) region of the hand - Spaces of the hand - Spaces of the hand - Spaces of the hand - Topography of the wrist - Anterior compartment of the wrist - Anterior compartment of the wrist - Anterior compartment of the wrist - Posterior compartment of the wrist - Posterior compartment of the wrist - Topography of the fingers - Topography of the fingers - Topography of the fingers ## Topography of the Scapular Region **Landmarks** - **Superior:** Horizontal line drawn through the seventh cervical vertebra. - **Inferior:** Horizontal line drawn through the inferior angle of the scapula. - **Lateral:** Vertebral border of the scapula to the acromion. - **Medial:** Medial margin of the scapula. **Layers** - **Skin:** - It is thick with limited movement. - It is traversed by the superficial and subcutaneous nerves and vessels. - It is innervated by the suprascapular nerve. - **Superficial fascia:** - It is a loose connective tissue layer. - It contains the subcutaneous fat with some superficial nerves and vessels. - It is traversed by the skin that is supplied by the lateral cutaneous branch of the third intercostal nerve. - It contains fat and cutaneous nerves. - **Deep fascia:** - It is a sheet of 2 layers: - Superficial layer covers the trapezius, deltoid and supraspinatus muscles. - Deep layer covers the suprascapular, infraspinatus, teres minor muscles and rhomboid muscles. ## Scapular Artial Network **Anatomy around the scapula** - **Arterial vessels in 3 zones:** - **Suprascapular zone:** - Suprascapular artery - Infrasuprascapular artery - **Subscapular zone:** - Subscapular artery - Dorsalis scapulae artery - **Axillary zone** - the axillary artery **Functions** 1. To provide collateral circulation when the subclavian artery or axillary artery is blocked or damaged. 2. To help protect the upper limb during injury. ## Topography of the Axillary Region **Landmarks** - **Anterior:** Lower region of the pectoralis major muscle. - **Posterior:** Lower edge of the latissimus dorsi muscle. - **Medial:** The descending from the level of the coracoid process and medial border of the serratus anterior muscle down to the medial epicondyle of the humerus. - **Lateral:** Line converging the margin of the pectoralis major, continuation along convering the medial border of the deltoid muscle. **Layers** - **Skin:** - It is thin and soft, smooth. - It contains hair, sweat glands, subcutaneous glands, and fat. - It is innervated by the intercostal nerves. - **Superficial fascia:** - It connects the superficial axillary lymph nodes. - It is traversed by the intercostal nerves of the medial cutaneous nerves in the arm. - **Deep fascia (axillary fascia):** - It surrounds nerves and vessels. - It surrounds the superior axillary lymph nodes. - It is traversed by the intercostal nerves of the medial cutaneous nerve and lymphatic trunk. ## Axillary Cavity **Borders:** - **Anterior:** Pectoralis major muscle is connected to the internal intercostal muscle. - **Posterior:** Subscapularis, Teres major and Latissmus dorsi muscle and the superior border of the Teres minor muscle. - **Medial:** Serratus anterior muscle and 1st and 2nd Intercostal muscles - **Lateral:** A ridge of the humerus and fat tissue of the coracobrachialis muscle and subscapularis muscle. **Contents:** - **Axillary artery:** is divided into 3 parts and 3 brachial vessels according to: - **Teres minor muscle:** Circumflex humeral and subscapular arteries. - **Pectoralis major muscle:** Anterior & Posterior circumflex humeral arteries. - **Lateral border of Teres major:** Subscapular artery, circumflex scapular artery, anterior & posterior circumflex humeral arteries. - **Axillary vein:** - it is formed by the basilic vein. - **Lateral axillary lymph nodes:** - Superior axillary lymph nodes - Central axillary lymph nodes - Subscapular axillary lymph nodes - **Posterior subscapular axillary lymph nodes:** - **Anterior (medial) axillary lymph nodes** - Axillary fascia ## Topography of the Deltoid Region **Landmarks:** - **Anterior & Posterior:** margins of the deltoid muscle. - **Clavicle:** - Acromioclavicular joint connects. - Spine of the scapula. **Layers:** - **Superior:** Line drawn on the deltoid muscle from the lateral end of the clavicle, converging with the inferior angle of the scapula. - **Inferior:** Edge of the scapula and the lower margin of the pectoralis major muscle and the medial epicondyle of the humerus. - **Anterior:** Anterior margin of the deltoid muscle. - **Posterior:** Posterior margins of the deltoid muscle. **Layers:** - **Skin:** - It is thick with limited movement. - Upper part of the deltoid muscle is covered by a part of the clavicle and a part of the coracoid process. - Lower half deltoid muscle is covered by a small part of the scapula. - **Superficial fascia:** - It contains subcutaneous fat with a few small vessels and branches of sensory nerves. - It contains subcutaneous nerves. - It is innervated by branches of the supraclavicular nerves. - **Deep fascia:** - It covers the deltoid muscle. - It is continuous with the fascia covering the deltoid and the anterior pectoral muscle. - It holds muscular veins, and branches of muscular arteries. ## Topography of the Infraclavicular region (Subclavian region) **Landmarks:** - **Superior:** Clavicle. - **Inferior:** Horizontal line drawn through the level of the 1st rib, moving over the superior angle of the sternoclaivcular joint (corocoid process). - **Lateral:** Lateral margin of the deltoid muscle. - **Medial:** Anterior margins of the deltoid muscle. **Layers:** - **Skin:** - It is thin and firm. - It is attached to the inferior edge of the clavicle and upper edge of the sternoclavicular joint, with a few small vessels. - It covers the muscular gap, extending from the superior mediastinum to the axillary fossa. - **Deep fascia (infraclavicular fascia):** - **Deep fascia (Infraclavicular fascia):** - It covers the pectoralis major muscle. - It covers pectoralis major muscle into 2 parts: Circumflex humeral and subscapular. **Borders of the Deep fascia (infraclavicular fascia):** - **Superior:** Clavicle. - **Inferior:** Parts of the coracoid process and a part of the clavicle. - **Lateral:** Medial foramen of the clavicle. - **Medial:** Lateral border of the subclavian fossa. **Borders:** - **Superior:** Clavicle. - **Inferior:** Parts of the coracoid process and a part of the clavicle. - **Lateral:** Medial foramen of the clavicle. - **Medial:** Lateral border of the subclavian fossa. ## Superior Trilateral Foramen **Borders:** - **Medial:** Trapezius muscle. - **Lateral:** Medial margin of the long head of the triceps brachial muscle. - **Inferior:** Teres major muscle, **Contents:** - **Axillary, suprascapular nerves.** ## Inferior Trilateral Foramen **Borders:** - **Lower angle of the scapula** - **Medial:** Longitudinal scapula, trapezius muscle. - **Lateral:** Medial margin of the Teres major, Teres minor muscle. **Contents:** - **The axillary artery** - **The subscapular nerve** ## Quadrilateral foramen **Borders:** - **Inferior:** long head of the triceps brachial muscle. - **Medial:** Lateral margin of the long head of the triceps brachial muscle. - **Lateral:** Superior margin of the latissimus dorsi. - **Superior:** Teres minor muscle and the infraspinatus fossa. **Contents:** - **Axillary nerves** - **Posterior circumflex humeral artery** ## Topography of the Shoulder Joint **Definition of the Joint:** - **Anterior:** Corocoid process of the scapula. - **Posterior:** Inferior to the acromion between the acromian spine, root of the spine of the scapula. - **Lateral:** Space between the acromion and the head of the humerus. - **Medial:** In front of the corocoid process of the scapula. **Type of join:** - **Diarthrodial:** Synovial, uniaxial, multiaxial, freely movable joint. - **Ball and socket joint:** - **Synovial joint:** - **Simple joint:** **Bone in the joint:** - **Spherical head of the humerus** - **Glenoid cavity of the scapula** **Articular capsule:** - **Connects surrounding the scapula:** From the glenoid labrum to the anatomical neck of the humerus, excluding the lesser tubercle - **The bicipital groove:** Is formed by the surrounding the capsule of the glenoid neck of the scapula to the greater tubercle, connecting to the lesser tubercle of the humerus. - **It encloses the shoulder joint:** Inside there is the synovial membrane, with the synovial fluid that prevents friction between the bones, and it allows the joint to move smoothly. **Ligaments:** - **Coracohumeral ligament:** - **Glenohumeral ligament:** - It connects posterior glenoid fossa to the greater tubercle. - **Superior glenohumeral ligament:** - **Middle glenohumeral ligament:** - **Inferior glenohumeral ligament:** - **Transverse humeral ligament** **Neurology:** - **Anterior and posterior circumflex humeral artery** - **Suprascapular artery, deltoid and circumflex scapular artery** - **Axillary artery, brachial plexus** - **Lateral and posterior cords of brachial plexus** - **Suprascapular nerve** - **Axillary nerve** - **Subscapular nerve** - **Nerve to teres minor** ## Topography of the Anterior Region of the Arm **Landmarks** - **Deltoid muscle** - **Pectoralis major muscle** - **Teres minor muscle** - **Long head triceps muscle** - **Teres major muscle** - **Medial and lateral epicondyles of the humerus** - **Lateral intermuscular septum of the arm** **Borders:** - **Superior:** Horizontal line drown from the pectoralis major and latissimus dorsi muscle. - **Inferior:** Horizontal line drown with a superior edge to the internal and medial epicondyles of the humerus. - **Medial & Lateral:** Vertical line drown in medial and lateral epicondyles of the humerus respectively. **Layers:** - **Skin:** - It is thinner than that on the opposite side. - It is innervated by the cutaneous branches of the axillary, intercostal, musculocutaneous nerve of the arm, and medial brachial cutaneous nerves of the arm. - **Subcutaneous fascia:** - It contains the cephalic and basilic veins. - It contains the lateral epicondyle. - **Deep fascia:** - It covers a serrating for the superficial veins and cutaneous nerves. - **Deep lateral inter muscular septum:** - It is a septum which is connected to the fascia surrounding the lateral and medial intermuscular septum. - There are 2 compartments: brachial region into anterior and posterior parts. - The anterior compartment is placed by the deltoid and superior parts. - The posterior compartment is placed by the latissimus dorsi muscle, triceps brachii, and medial epicondyle. - The lateral compartment is covered by the deltoid muscle, and its superior surface of the latissimus dorsi. ## Topography of the Posterior Region of the Arm **Landmarks:** - **Deltoid muscle** - **Teres minor muscle** - **Coracobrachialis muscle** - **Long head biceps muscle** - **Teres major muscle** - **Medial and lateral epicondyles of the humerus** - **Lateral intermuscular septum of the arm** **Borders:** - **Superior:** The horizontal line down from the pectoralis major and latissimus dorsi muscles. - **Inferior:** Horizontal line drawn which is 1 finger above the internal and medial epicondyles of the humerus. - **Medial & Lateral:** Vertical line drown in medial and lateral epicondyles of the humerus respectively. **Layers:** - **Skin:** - It is thick and well-connected with the subcutaneous tissue. - It contains the superior lateral cutaneous nerve of the arm, inferior lateral cutaneous nerve of the arm and posterior cutaneous nerves of the forearm. - **Superficial fascia:** - It covers a serrating for the scapula to the lower edge of the triceps muscle. - **Deep fascia:** - It covers a serrating for the scapula to the lower edge of the muscle. - **Deep posterior intermuscular septum:** - It lays a converging for the scapula to the lower edge of the muscle. - It contains the radial nerve, deep brachial artery of the arm and radial veins pass through this canal of the arm. ## Canal of the Radial Nerve - Spinal round humeral epicondyle **Topography:** - It is surrounded by the humerus and the lateral muscle which is long head and lateral head. - It contains the radial nerve strip of the arm and the arm. ## Topography of the Elbow Region **Landmarks:** - **Distortion of the arm.** - **Brachioradialis muscle** - **Tendon of the biceps brachia muscle.** - **Medial and lateral epicondyles of the humerus.** - **When muscles are applied in the arm:** - The epicondyle, radial and ulna radial nerve easily visible. ## Topography of the Cubital Region **Borders:** - **A horizontal line:** It is from 2 to 3 fingers from the medial epicondyle of the arm and the lateral epicondyle, which is located at the borders of the triceps muscle. - **Vertical line:** It is drown through the medial & lateral epicondyles of the humerus. - **It divides the cubital regions into:** - Anterior cubital region - Posterior region ## Topography of the Anterior Cubital Region **Layers:** - **Skin:** - It is thinner than that on the opposite side. - It contains sweat glands, sebaceous glands of fat. - It is traversed by the lateral and medial cutaneous branches of the arm, and internal and medial cutaneous nerves of the forearm. - **Superficial fascia:** - It contains superficial fascia with subcutaneous fat and nerves. - It contains subcutaneous nerves. - It contains the cephalic, basilic and median cubital veins. **Layers:** - **Superficial fascia:** - It is connected with the fascia, overlying the anterior and lateral margins. - It is connected with the fascia, overlying the anterior and lateral margins of the forearm. - **Deep fascia:** - It is continuous with the fascia of the elbow and forearm. - It separates the tendons of the biceps brachia muscles from the medial and medial brachial muscles. - These nerves are found in the medial and lateral epicondyles of the humerus: - **Ulnar nerves.** - **Muscles group of the elbow:** - **Pronator teres muscle:** It is located in the medial epicondyle. - **Flexor carpi radialis muscle:** - **Palmaris longus muscle:** Runs along the radius and ulna. - **Flexor digitorum superficialis muscle:** Runs along the radius and ulna. - **Flexor digitorum profundus muscle:** Runs along the radius and ulna. ## Topography of the Anterior Cubital Region **Borders:** - **Deep to the Lateral epicondyle:** - **(Supracondylar or triangular fossa):** This is a triangular space found on the anterior surface of the humerus. The apex of this triangular fossa lies superiorly between the medial and lateral epicondyles. The base of the triangular fossa is inferiorly, formed by the superior margin of the radial tuberosity. The lateral margin of the triangular fossa is formed by the lateral epicondyle. The medial margin of the triangular fossa is formed by the medial epicondyle. **Borders Deep to the triangular fossa:** - **Lateral epicondyle:** - **Medial epicondyle:** - **The superior margin of the radial tuberosity.** **Layers:** - **Skin:** - It is thinner than that on the opposite side. - It contains sweat glands, sebaceous glands of fat. - It is traversed by the lateral and medial cutaneous branches of the arm, and internal and medial cutaneous nerves of the forearm. - **Superficial fascia:** - It contains superficial fascia with subcutaneous fat and nerves. - It contains subcutaneous nerves. - **It contains the cephalic, basilic and median cubital veins.** - **Deep fascia:** - It is connected with the fascia, overlying the anterior and lateral margins. - It is connected with the fascia, overlying the anterior and lateral margins of the forearm. **Muscles group of the elbow:** - **Pronator teres muscle:** It is located in the medial epicondyle. - **Flexor carpi radialis muscle:** - **Palmaris longus muscle:** Runs along the radius and ulna. - **Flexor digitorum superficialis muscle:** Runs along the radius and ulna. - **Flexor digitorum profundus muscle:** Runs along the radius and ulna. **Structures:** - **Brachial artery:** It is passes though the supracondylar fossa. - **The radial nerve:** It is situated in the upper level of the humerus. - **The superficial brachial artery:** It can be easily palpated in the groove, between the brachioradialis and brachialis muscles. - **Ulnar nerve:** It is situated in the upper level of the humerus. - **Median nerve:** It is situated in the upper level of the humerus. **Structures:** - **The brachial artery:** It is passes though the triangular fossa. - **The radial nerve:** It is situated in the upper level of the humerus. - **The superficial brachial artery:** It can be easily palpated in the groove, between the brachioradialis and brachialis muscles. - **The ulnar nerve:** It is situated in the upper level of the humerus. - **The median nerve:** It is situated in the upper level of the humerus. ## Topography of the Posterior Cubital Region **Landmarks:** - **Olecranon of ulna** - **Ulnar nerve** - **Medial and lateral epicondyles.** **Layers:** - **Skin:** - It is thick and movable. - It forms the elbow. **Structures:** - **Subcutaneous fascia:** - It surrounds the posterior region. - It connects the posterior compartment of the arm, surrounding the tendons and vessels of the humerus and medial epicondyle of the humerus. - Borders of the elbow joint extend to the upper part of the olecranon of the ulna. - **Basilic vein:** It is positioned for venous compartment of the arm. - **Deep fascia:** - It is a thin layer with William fascia. **Structures:** - **Deep fascia:** - It is surrounded by the epicranium. - It is located to the tendon of the triceps brachii, surrounding the medial and lateral epicondyles of the humerus, and olecranon of the ulna. - **Skin:** - It is thick and movable. - It forms the elbow. ## Topography of the Elbow joint **Definition of Joint:** - **Position of Joint:** It is drown in the lateral epicondyle and ulna, close to the medial epicondyle of the humerus. **Type of joint:** - **Diarthrodial:** Synovial, uniaxial, freely movable joint. - **Hinge joint** : Flexion / Extension - **Pivot joint:** Pronation / Supination - **Ball and socket joint:** - **Compound joint:** - **Concentric joint:** - **Compound joint:** **Bone in the joint:** - **Lateral epicondyle of the humerus** - **Coronoid process of the ulna** - **Trochlea of the humerus** - **Articulation of the olecranon** - **Olecranon fossa of humerus** - **Radial head with Radial neck** - **Lateral epicondyle of the humerus** - **Olecranon fossa of the humerus ** - **Coronoid fossa of the humerus ** - **Articulation of the radial head** - **Capitulum of the humerus** **Ligaments:** - **Radial collateral ligament** - **Ulnar collateral ligament:** - **Annular ligament of radius** **Neurology:** - **Posterior and posterior intermuscular septa** - **Brachioradialis, pronator teres and flexor carpi radialis** - **Ulnar nerve:** Passes through the medial compartment. ## Topography of the Forearm **Layers:** - **Skin:** - It is connected to the anterior and posterior compartment. - **Anterior compartment of the wrist:** - **Landmarks:** - **Radial groove, palpable:** - It’s easy to tell on the superficial side of the forearm. - It corresponds to the radial styloid process. - **Flexor carpi radialis tendon:** - Flexor carpi ulnaris tendon and the radial artery can be palpitated during extension of the wrist. - **Ulnar nerve:** - It can be palpated in the ulnar groove. - **Palmaris longus tendon:** - It is visible when the forearm is held in a state of moderate tension. - It is situated in the median cubital vein of the arm. - **Flexor digitorum superficialis tendon:** - It is located to the radial artery. The superficial and deep layers of the flexor digitorum superficialis tendons can be palpated separately. - **Flexor digitorum profundus tendon:** - It is located to the ulnar artery. - It is located in the groove, between the flexor carpi ulnaris tendon and the flexor digitorum superficialis tendon, but cannot be palpated - **Flexor digitorum superficialis tendon:** - It is located to the radial artery. - This tendon can be palpated in the groove between the radial nerve and the flexor carpi radialis tendon. - **Flexor digitorum profundus tendon:** - It’s located to the ulnar artery. - It’s located in the groove between the flexor carpi ulnaris tendon and the flexor digitorum superficialis tendon, but cannot be palpated. ## Topography of the Anterior Region of the Forearm **Structures:** - **Subcutaneous fascia.** - **Lateral:** - **Radial artery and vein** - **Superficial border of the radial nerve:** - **Medial:** - **Ulnar artery** - **Ulnar vein** - **Cephalic intermuscular artery** - **Medial intermuscular artery** - **Median nerve** - **Palmaris longus:** - **Posterior intermuscular artery and nerve** ## Topography of the Posterior Region of the Forearm **Layers:** - **Skin:** - It is thick and movable. - It is traversed by the superficial and subcutaneous nerves of the arm. - It’s traversed by the superficial and subcutaneous nerves of the forearm. - **Subcutaneous fascia:** - It contains the superficial fascia of the forearm. - It contains the superficial fascia of the forearm. - It contains many small vessels and nerves, including those supplying subcutaneous tissue and skin. - **Deep fascia:** - **It surrounds the extensor muscles, with the nerve and tendons:** The deep fascia splits to surround these structures, forming compartments. - **It surrounds the dorsal (posterior) compartment of the forearm:** A thick, fibrous sheath that covers the muscles and nerves. **Layers:** - **Skin:** - It is thick and movable. - It is traversed by the superficial and subcutaneous nerves of the arm. - It’s traversed by the superficial and subcutaneous nerves of the forearm. - **Subcutaneous fascia:** - It contains the superficial fascia of the forearm. - It contains the superficial fascia of the forearm. - It contains many small vessels and nerves, including those supplying subcutaneous tissue and skin. - **Deep fascia:** - **It surrounds the extensor muscles, with the nerve and tendons:** The deep fascia splits to surround these structures, forming compartments. - **It surrounds the dorsal (posterior) compartment of the forearm:** A thick, fibrous sheath that covers the muscles and nerves. ## Spaces of the Forearm **Anterior compartment of the forearm:** - **A triangular space:** It is located between the 4th and 5th digits, palmar aponeurosis and radial nerve. - **A triangular area:** Its located between the flexor carpi ulnaris tendon, the tendon of the flexor digitorum superficialis and the flexor digitorum profundus. **Posterior compartment of the forearm:** - **A small space:** It is located between the flexor carpi ulnaris tendon and the extensor muscles. - **Space:** Its found on the posterosuperior aspect of the forearm. - **A triangular area:** Its located between the flexor digitorum superficialis and the flexor digitorum profundus. **Posterior compartment of the forearm:** - **It’s located between the 4th and 5th digits, palmar aponeurosis and radial nerve.** - **It’s located between the flexor carpi ulnaris tendon, the tendon of the flexor digitorum superficialis and the flexor digitorum profundus.** **It’s located between the flexor carpi ulnaris tendon, the tendon of the flexor digitorum superficialis and the flexor digitorum profundus.** ## Topography of the Wrist Joint **Type of joint:** - **Diarthrodial:** Synovial, uniaxial, freely movable joint - **Complicated joint:** - **Ellipsed joint:** This joint is signified in two parts. - **Biaxial joint:** **Bone landmarks:** - **Inferior/distal surface of the radius** - **Proximal row of the carpal bone (scaphoid. lunate, and triquetrum)** **Articular capsule:** - **It encloses the joint.** - **It’s adjacent to the styloid process of the radius and ulna, proximal row of the carpal bones.** - **Synovial membrane:** Traverses the fibrous capsule. - **Position of the styloid process:** It directs the proximal row. - **It lies in front of the styloid process of the ulna:** It is in the space of the wrist, between the ulna, distal surfaces of the radius. - **On the palmar surface, the tendons** follow the carpal joint. **Ligaments:** - **Palmar ligament:** - **Radial collateral ligament:** - **Ulnar collateral ligament:** - **Palmar ligament:** - **Palmar radiocarpal ligament:** - **Palmar ulnocarpal ligament:** - **Dorsal ligament:** - **Dorsal radiocarpal ligament:** - **Dorsal ulnocarpal ligament:** **Arterial region:** - **Palmar carpal arches:** - **Dorsal carpal arches:** - **Anterior part of the wrist compartment:** - **Axillary artery** ## Topography of the Hand Region **Landmarks:** - **Styloid processes of the ulna and radius** - **Distal end of the wrist joint** - **Hypotenar eminence** - **Thenar eminence** - **Phalanges of fingers** **Borders:** - **It’s where the styloid process of the ulna:** It’s located in distal end of the radius and ulna. - **It’s allows a horizontal change:** The ulna and radius and distend the hand region into the medial and lateral hand region (dorsal region). ## Topography of the Anterior (palmar) Region of the Hand **Layers:** - **Skin:** - It is thick with limited movement. - It contains sweat glands and subcutaneous glands. - It is innervated by the radial nerve, ulnar nerve and median nerve. - **Subcutaneous fascia:** - It contains nerves, artery and lymphatic vessels with hypodermic nerves. - It’s continuous with the superficial palmar arch of the wrist and the forearm. ## Topography of the Anterior (palmar) Region of the Hand **Deep fascia:** - **It is a continuation of the deep fascia of the forearm.** - **It is thin, strong and fixed by the flexor retinaculum:** this retinaculum is a strong fibrous band that holds the tendons of the flexor muscles in place. - **Covering layer:** It is contiguous with the deep fascia of the forearm. **Structures:** - **It’s long & highly specialized:** It has extensions, or radial and ulnar ligaments. - **Palmar aponeurosis:** It is strong and thick, formed by the tendon of the palmaris longus muscle. - **Finger flexors:** Proximal part of the hand, the tendons of the flexors of the fingers are found in the following order: 1. Flexor pollicis longus 2. Flexor digitorum superficialis 3. Flexor digitorum profundus tendon (with ring finger) 4. Flexor digitorum profundus (with little finger) - **For an interosseus digit, ** they are located in the palmar region. ## Topography of the Anterior (palmar) Region of the Hand **Structures:** - **These muscles align with the radial nerve** - their palmar surface is part of the thenar eminence: - Flexor pollicis brevis muscle - Abductor pollicis brevis muscle - Opponens pollicis muscle - Flexor pollicis longus muscle - Flexor digitorum superficialis muscle - Flexor digitorum profundus muscle - **Palmar is longus group:** Scaphoid eminence - **Palmar interosseus muscles, dorsal interosseus muscles** - **Hypothenar muscles:** - Flexor digiti minimi brevis - Abductor digiti minimi - Opponens digiti minimi ## Topography of the Posterior (dorsal) Region of the Hand **Layers:** - **Skin:** - It is very rough. - **It contains the dorsal venous network:** This network is made up of a series of interconnected veins that drain blood from the hand. - **It contains the extensor tendons:** These tendons run along the back of the hand, allowing for extension of the fingers. - It contains the palmaris longus and ulnar nerves. - It’s traversed by the tendons of the extensors of the fingers, radial nerve, ulnar nerve, dorsal carpal arch. **Subcutaneous fascia:** - **It contains fat, vessels and nerves:** It’s located between the skin and deep fascia. **Deep fascia:** - **It forms the extensor retinaculum:** Its located on the dorsal surface of the hand and consists of a strong fibrous band. - **It’s located:** The dorsal surface of the wrist and the hand: The deep fascia splits into compartments that surround the tendons and nerves. ## Topography of the Posterior (dorsal) Region of the Hand **Deep fascia:** - **It forms the extensor retinaculum:** It’s located on the dorsal surface of the hand and consists of a strong fibrous band. - **It’s located:** The dorsal surface of the wrist and the hand: The deep fascia splits into compartments that surround the tendons and nerves. **Structures:** - **Tendon of the extensor carpi ulnaris muscle:** - **Tendon of the extensor digitorum muscle** - **Tendon of the extensor digiti minimi et extensor indicis tendons** - **Tendon of the extensor pollicis longus tendon:** - **Tendon of the extensor carpi radialis longus and extensor carpi radialis brevis tendons** - **Tendon of the extensor pollicis brevis and abductor pallicis longus muscle** ## Spaces of the Hand **Spaces are found between the metacarpals and the dorsum of the hand.** They are distended in the palmar and dorsal regions. **Dorsal compartment:** 1. **Hypotenar space of the hand** 2. **Thenar space** 3. **Midpalmar space** 4. **Dorsal space:** **Dorsal compartments